Healthcare Provider Details

I. General information

NPI: 1326370305
Provider Name (Legal Business Name): NEWTON MEDICAL FAMILY PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7143 TURNER LAKE RD NW
COVINGTON GA
30014-2066
US

IV. Provider business mailing address

5126 HOSPITAL DR NE
COVINGTON GA
30014-2566
US

V. Phone/Fax

Practice location:
  • Phone: 770-788-9970
  • Fax: 770-788-9875
Mailing address:
  • Phone: 770-385-4183
  • Fax: 770-385-4281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number06558
License Number StateGA

VIII. Authorized Official

Name: WILLIAM LOVE
Title or Position: DIRECTOR, NEWTON MEDICAL GROUP
Credential:
Phone: 770-385-4183